| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,419 |
1,969 |
$268K |
| D0330 |
Panoramic radiographic image |
5,305 |
5,251 |
$223K |
| D2722 |
|
222 |
125 |
$192K |
| D0274 |
Bitewings - four radiographic images |
7,274 |
7,226 |
$189K |
| D1110 |
Prophylaxis - adult |
4,691 |
4,680 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
6,114 |
6,088 |
$134K |
| D1206 |
Topical application of fluoride varnish |
6,960 |
6,927 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,278 |
8,202 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,460 |
1,375 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
10,384 |
10,000 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
4,060 |
3,918 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,177 |
4,144 |
$81K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
995 |
560 |
$66K |
| D1120 |
Prophylaxis - child |
2,779 |
2,775 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,465 |
955 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
329 |
230 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
692 |
474 |
$24K |
| D7250 |
|
619 |
234 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,182 |
1,167 |
$19K |
| D1351 |
Sealant - per tooth |
792 |
190 |
$18K |
| D4355 |
|
723 |
714 |
$16K |
| D2331 |
|
310 |
217 |
$14K |
| D5110 |
|
138 |
136 |
$14K |
| D5225 |
|
12 |
12 |
$13K |
| D2160 |
|
188 |
127 |
$13K |
| D1330 |
|
1,280 |
1,273 |
$12K |
| D1354 |
|
104 |
28 |
$3K |
| D2140 |
|
49 |
40 |
$2K |
| D2330 |
|
94 |
68 |
$580.68 |
| D0273 |
|
13 |
13 |
$25.12 |
| D5120 |
|
12 |
12 |
$0.00 |
| D2335 |
|
16 |
12 |
$0.00 |
| D5214 |
|
82 |
82 |
$0.00 |
| D0270 |
|
237 |
237 |
$0.00 |
| D2332 |
|
50 |
37 |
$0.00 |
| D9951 |
|
15 |
14 |
$0.00 |